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Patient Story

A young girl is seen for multiple papules and pustules on her lower abdomen (Figure 100-1). Further questioning demonstrates that she was in a friend’s hot tub twice over the previous weekend. The outbreak started after she went into the hot tub the second time. This is a case of Pseudomonas folliculitis or “hot tub” folliculitis. The patient avoided this hot tub and the folliculitis disappeared spontaneously.

FIGURE 100-1

“Hot-tub” folliculitis from Pseudomonas aeruginosa in a hot tub. The folliculitis tends to be distributed under or around the bathing suit. (Used with permission from Daniel Stulberg, MD.)

Introduction

Folliculitis is an inflammation of hair follicles usually from an infectious etiology. Multiple species of bacteria have been implicated, as well as fungal organisms.

Epidemiology

  • Folliculitis is a cutaneous disorder that affects all age groups and races, and both genders.

  • It can be infectious or noninfectious. It is most commonly of bacterial origin (Figure 100-2).

  • Pseudofolliculitis barbae is most frequently seen in men of color and made worse by shaving (Figure 100-3).1 It is also known as “razor bumps” and can start in the teen years with the onset of shaving.

  • Acne keloidalis nuchae or keloidal folliculitis is commonly seen in black patients, but can be seen in patients of any ethnic background (Figures 100-4 and 100-5).2 Like pseudofolliculitis barbae, it is exacerbated by shaving.

  • Methicillin-resistant Staphylococcus aureus (MRSA) can pose a challenge to the treatment of folliculitis (Figure 100-6).

FIGURE 100-2

Close-up of bacterial folliculitis showing hairs coming through pustules. A culture grew out Staphylococcus aureus. (Used with permission from Richard P. Usatine, MD.)

FIGURE 100-3

Pseudofolliculitis barbae in a young black man. Also known as “razor bumps” this started in his teen years with the onset of shaving. (Used with permission from Richard P. Usatine, MD.)

FIGURE 100-4

Acne keloidalis nuchae with inflamed papules and pustules on the neck of a young Hispanic man. (Used with permission from Richard P. Usatine, MD.)

FIGURE 100-5

Acne keloidalis nuchae with inflamed papules and pustules on the posterior neck and scalp of a young African American man who shaves his head. (Used with permission from Richard P. Usatine, MD.)

FIGURE 100-6

MRSA folliculitis in the axilla of a young woman. The lesions were present for 4 weeks in the axilla, left ...

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